Document yrrdV3vD73Ep0Oer9vjR25qZE

: juiMCKT iVEM^**JI, ISp7 ORIGINAL ARTICLES- THE LANCET 1017 tcRbnl - y in the eph f hO'.-t'c ble miki aracliiMiid nck-s amt diipigm .cncmlslt jglnt lie of filling:" arachnoid sbly ran? 961) but ' happen Radbvrp r scciwftfti jut, air c conical zb *bly tw* s nnne a normal hategpaai `e 10 ex* uch there ' tilling ubarach*' he A.P.U peencepeikivr om - the munioi* *& I <*- -J utarads- In our vesurilwity. was * result dilatation atrophy. ,d to an he CAr> if (hn grows* a. c tWMopr ay fit (hr -item > fur- ihr ettsn and *f retWrie. pe enceJcs |." ortnaunn S Iso KM' tionViih to' the t of teat ephaJni vpoctcilr o a coma rf CS.F. with the hotepe solution may be expected to cause fe* disturbance to the cu. system than the injection nf air. (4) Finally, air miceted during the A.E.G. is reahMiriwd very ibwty in commuftseatigig hydrocephalus, and ns presence may MmL curative surgical treatmeat because of the risk of air dahdims. These a ae such risk after isotope encephalography. FCAL EXCRETION OF LEAD BY CHILDREN D. Ba r l t r c p M.D.. B.Se. Lend.. AUl.C-f., D.CH. Sfvioa noinui It must tac reengtmed that isotope encephalography is i eiually complementary to a .e.g . and does not supplant it S'. J; P. KlLLALA h.A: t'aiuf. i m tltr ihveMiipilimt *if pnijsresMve dementia. 'I*hv a.k m;, uinii u MriUMT may show more clearly than isotope encephalography, Hrtm Ik- 1'uM-itru Van, Si, .tlai.i i I!U`Jt,'ai &M, iucal blockage in the basal cisterns and dilatation of Laeatin ir.i interns caudal to she blockage (Crunqutal 1967). How* ' ever, if (for example, after subarachnoid hxmorrhage or kad injury or meningitis) obstruction due to a tumour can He excluded, from the history, isotope encephalography may become the investigation of choice in a patient with inspected communicating hydrocephalus. The relation between ventricular size and CJ.F. pressure Summary Faxal lead it a sensitive index of ingested lead. Normal values for children aged 2 years have been determined and contrasted with the find ings in three cases of lead poisoning. Fscal lead deter minations have a place in population screening programmes and in the interpretation of blood-lead values in children. n communicating hydrocephalus has attracted consider' iMroduetiaa - interest lately. An early case of communicating Th e detection of chitdten abnormally exposed to lead ' zrec.-phalus after subarachnoid haemorrhage with has previously depended upon a history of pica, elevated iieul c.id. pressure was described by Foltz and Ward blood and urine lead levels, and evidence .of disturbed iW56). Adams-et al. (1963) have described further cases porphyrin metabolism. None of these methods has proved ml have introduced the term " normal pressure hydro, to he satisfactory in the detection of exposed as opposed .iphalus ", This teftp is perhaps misleading because it is to poisoned children 'Harltnip 1456, 1467.. Although likely that the cu. pressure b raised at some stage of the emphasis has been placed on the determination of blood- Jt-.-ase. Analogies -viti a simple physiol system have lead (MoocrielT et al. 1964, Gordon et al. 1467), the J hen discussed by Adarts et al. (1965) and these workers significance of moderately elevated values may be doubtful *ure pointed out that if the vi ltimt of such a system since they may indicate release of bound skeletal lad A.rejsvs then the force on the wall may increase even if rather than recent lead ingestion .Bvcrs and Makvf 1954). "i ilk-actual pressure within the system remains the same, The administration of lead compounds to human adult* fhc analogy has, ho-.-ever, only indirect application , (Refuse 1461) and to animals .Blister 1950) is accompanied - tvemse the resistance >:i she 'entricular wall is unlikely to : by increased faxal levels and at: least 90".. of the ingested hr uniform. 'S'hatevcr the :<.ccry, the fact of the matter is lead is unabsorised. Childten with lead poisoning also 1 fca patients `with* Simmunkatiag hydrocephalus and | "aurmal cerebrospinal-fluid pressure" improve if the have a raised fscal lead (Ghhotm and Harrison 1956)'but little advantage has been taken: of this either in the detec ftissurc is lowered. tion of children abnormally exposed to lead or in the -`Chat is the cause of communicating hydrocephalus in interpretation nf elevated bkuad-fcvds. fauents in whom there is no history of subarachnoid Frcliniiiury animal wvrkia<afinncd that lareal lead was knnutrhage, head injury, or meningitis ?. These patients a sensitive index of the ingestion of lead compounds com nbt.be distinguished, on clinical grounds or on pared with blood and urine measurements. The findings aresugation, from the patients with an obvious cause, were applied to healthy and'lead-poisoned children. throgh in one patient the u.?. protein was slightly raised. It -tenis probable that there is a similar obstructsen to i-t-h flow in both groups of patients, though the pathsHmI cause may be different. Further work is needed to .eoMbh whether there is a chronic arachnoiditis or P-dhh: late decompensation of tog-standing communi- - Metheds - Children of both sexes aged 24-35 months w ere investigated, coinprising four groups: Cramp Consecutive hospital inpatients admitted during the study period with illnessesother than lead poisoning. (irimp //.--Ui-althy children tifunseleeted mothers attending .xmg hydrocephalus in those patients without any j- local mfahl-wvllare clink. No history tif ptea or mouthing *u.-us preceding cause. Our present ignorance about the rmlagy in such raises need nut halt the search for patients safe communicating hydrocophahis who can be helped by .tati.-vioaKrial drainage. i. daafc the pbyucaiHn anil wfgMH ef ibc National Hospitjls Vis-nMUtsI w to studyifmn under their ewe and lit- jjmc. i 4 s* ftm lulp and AKMuraoronvM. Kii|wU kir irvpmtts sbmild *Ck- aldmvil In R. H.. Kaijnnat ILy**, 5sr Nervous Biassiwi, Qiasen Square, Limdiai Ti.C.I. EES'ESUJKCES for pamted nuicroli for 7 days preceding interview. O'nwp 111.--As group it but with a positive history of pica or mouthing for painted materials during the 7 days preceding interview. Group /I".--Hospital inpatients admitted for treatment of lead poisoning. The tint stool passed hy each child after admission to hos pital or i!k - dime interview was coHCelvd directly into i poly ethylene hag, urim^was separated in the laboratory and dis carded. All fxcal specimens were homogenised with distilled deionised u-ater In an * Ato-Mix * blender and a weighed Uw B. D. (!*; Puts. IS. Sm. ML St. ft. sample was obtained. Serial fscal collections were made from ' fi*ei C M-, HAin. L, OjmuA 1L C!., Sweet, W. H. (IMS) XmBstt.J. Mid. 273. ||7. IIWIM. S. (ll Hr: J. HedMI 4*. . / <Sm.fi. (lMal7. Am. Out. An. Ilf, 534. two of the cases of lead poisoning and also from an ambulant child with mild cerebral palsy on a 'normal ward diet. Venous blood specimens were obtained from children with lead poison - mUM Melon. I,-ml. SM. J. K. I,, Vmd A. A.. Jr. . IVSM J>. Kiannag. JS. S44. |i. WaJtXft. f.. (IMS) iM. a, SSL II. Law, C W.HMD AM.'Aw; T. 12*. R. P^CMqb, &. S. C, Onnona, M. X. (IMt) Hrent, M. *3. ing with disposable syringes and needles and collected in heparuuted polystyrene tubes.' N Lead was analysed aftetj preliminary wet^digestien using a aemiautonuited alkaline ditbiaoM mi ethod (Stowett and Moss 0007-SWP-000005846 N11874 <*c Ir l)um mihir Th. child? si* *n larui a (Ini' n mIh .1 hc l.> ihcl'l Invl* capn Th I Urr. KVlit, arc v 104 o alihin Irani- Th puis<H uatn feprclaws m*m:: t.i rami luuiri aMi: in tin n.v f mlnll Th. of Ur r. k . rha- . ahn. >r pr* vc aiiHin f .,i tinltlr tcnirt impof rccurr of ;in * atkw* vcriiit . . lit lluif rv c 21 ffm m itrjiiL U m ad y fie iy lO '*! * g. a sc nm -a ml in* n a m.3 awaw 1, ml * PkElIMlNAItY COMMUNICATIONS -i- THE LANCS? 1019 feraga 3 n. ttl Mi MIMl *f S.8. ii 01 a 0 rft"'fiter---- . JJT 7 SI DAYS Hi. 4--Strial fonlM dMmnlnailwn far n mMm inoatioai (wind value* Ariv4 from |nv* 31 and Sill. During i 2"Week period the i'scai lead eastern fluctuated aithin, but did not exceed, normal limit! (fig. 4). DiKHilan fumed the lead analyses. This nock was undertaken during tha tenure uf a grant from the Medical Revcarch Cwincd ta one of us (Oil.). Kcqunt* fur reprint, should be sddreued to D. 8. ari-iars-CKS' Aub. J. II.. I-'auiull. I.. T . Mum. A. S.. ReiniSwf. P. , IU*i .Ifadbate ITawnr I. 71. Bathrio. D. (ISM: Am J. I*'. CkU til. I la. -- tmfj rliM fihJ. (idiJ 3^. jW, Wiinrr. ii, I. vl^ 7 TdJ*. . IV H*aartl. i. tf.-LMa--. K !***- f K ?1 User*. K. K^btriiw(.4:.!*# >. 1* 97. A** I. Jj |f-a ildrthMi. M.>- IVH I*. *43. S.. Km*. K. Mdafcdk, K. 1. t<*7 to* W. J. a, 4*0. A H/rt. Jl. HH.* MriWsWlT.A. A..Kh mHiu KO P.(Lv im.L.KifiAfA. D.Sttftvkfc. A. i. C. Ksthcqfo. (.. H- Auks Un. 1. ' Prelimlnaiy Communications The rapid return io normal of the fascal lead conient of .hildren who had ingested lead compounds, after admin* k<n to hnpiial and the almost quantitative transient far,al ekvation after single-drive adminatrarionof lead to * dug, both support the suggestion that the ftccal lead is eklicaiivc of ingested lead. Since lead can be detected in PLASMA-ZINC CONCENTRATIONS IN PATIENTS WITH PSORIASIS, OTHER DERMATOSES, . AND VtiNOL'S LEG ULCERATION Ac faxo alter ingestion without concomitant increase in ihc lAmd and urine levels;, wc suggest that blood and urine Inch be abandoned as methods for the detection of tsp>cd children. The mean normal value of 130 ;g. lead per specimen is dmilar to that of 132 ;tg. described by Chisolm and Harrison (1956) for children aged 12-35 months. Mow* ocr, the faecal lead observed in cases 1-3 (0-57-1-9 mg.) are cunsiderably lower than those repotted by them (5-0|om mg.). The reason for this discrepancy is nut clear ililaxigh many of Chisolm's cases were severe and had frank cneephalupathy. The lutal lead ingested by children who become jpuMuicd fas relevant to legislation on paint and surface 'outing. If the first stool passed on admission to hospital Kprescms the daily lead intake before admission, then os> I and 2 ingested 160-310 mg. uf lead during 5-6 - These figures compare with the whole-body lead 220 mg. of a child who had died after pica for lead paw described by Aub ct al. (1926). Deductions uf this nature may be erroneous, since anorexia, vomiting, and i.vMi[\ni<>n are well-rccognised features of lead pofawming Summary Significantly lowered plawna-zmc concen trations wen.* found in patients with pstiriasis, other dermatoses, and venous kg ulceration. The significance uf this finding requires further inveftigsh- tion. ^ IXTBOOCCTIOS Zin c is an essential dietary constituent; it is a com ponent uf several metalloenzymes and behaves as a cu-factor for many other enzymes. Although in man low plasma or serum zinc concentrations have been associated with einbnsis uf the liver 1 and the postoperative period,3 and reduced amounts uf zinc have been luund in the hair of patients with atherosclerosis,-* systematic Studies of zinc metabolism in human skin disease have nut been reported. We have, thercfbte, determined plasma-sine concentra tion* in a group uf patients with psoriasis, a group with ichthyosis, and a group with miscellaneous skin euaditions. Because of the recent observation by Porks ct ah* of accelerated wound healing after zinc administration; we also studied a small group ofpatients with c(m>nic venous ulceration of the leg. in thildrcn and were present in the cases reported here. sirajFCTs *xn me t h o d s I hr experimental ingestion of 3-0 mg. of lead daily by an The subjects studied were ago) 15-64 year*, and were in fire jduli resulted in unacceptably high blood and tissue lead groups: (1) 41 healthy subjects^(including 17 females! with ns ovK\mrjiiuns sites 4 mcadas (Kchoc 1961). past history ofskin diseasc;(2) 20 patients (including 9 females) Thi. technique may' have advantages for the screening <f targe numbers of young children, since the specimens tre cj'ily ohtamed and transported. Tine demonstration tlui at least one otherwise healthy child |iad ingested an aNsnmal amount of Head supports this, and indicates that preventive measures might be applied before toxic with psoriasis involving 10".. Or more of the body-surface; (3) 13 patients (including 7 females' with miscellaneous skin conditions in which neither dyskeratosis nor chronic ulceration was a ifeature; (4; 10 patients (including 2 females) with ichthyosis; 'S) 9 patients (including ( females) with chronic venous leg ulceration. Venous bloud samples, collected using disposable plastic ttuuums uf lead have been absorbed. syringes and stamfess-sieel needles, were each transferred to Iifarvrsirjf, after treatment frir lead poisoning, some a pulyeiyrcnv vpeunK-n tube and mixed with I drop of heparin thildiren may be found lo Haw: elevated blood-lead con- (heparin injcttiun lt.l`,, Snmi unit* per ml.. Weddell Pharma temramrts for several weeks. In such circtmisianccs it is fajiporiant to discover whether or not there has been a raarreticc of pica for !ead-eomairang materials. The lack if issnciaiiium between th blued arid ftccal (cad contents iSows this distinction to be made arid provides objective ceuticals 14d.).* Within 2 huurs of collection, the specimens were cfantrifngcd at MW r.p.m. (M.S.E. `'Minor * centrifuge) for 10 rpinutes; the plasma was separated, and stpred at -20 C in polystyrene tubes. I, fraud. A. S.. Cbrilr**. D. Habtr*d. ). K J. lak. AUi. IMS, trnlkatiiin uf the pies history. 1. Sinw. ST. H , Sib, C. G . lime*. V. J., Hrawm, J. Mmura, ].. V Hunk Or. P. J. N, Co b. Dr. Z. MencridT, Dr. T. EL Orpi, and IV U. Sfcdfev for penmuimi to report details of children under it are. 1ST. H. nmcoe^Saith Ikindly granted ms focilities at a rtvr. W.. HasSim. J. 7Vw Am. ami. Su. ml. M. M. 3- Sirara, W. H.. Pmm. W. J. im Zbx Mrutolte* (c CmO tor A. . fraud)i Pi 371. SarinaArM. BL. IMS. 4. fern V. J.. Hk w U, J. K, gab. C C.. Suaa. W. SI Amt. fo|. i I'm < Tetunhnier Infant Welfare Clinic Mias $.. r IM7. IS. 432. Cj i 0007-SWP-000005848